Chd classification

TGA

CORONARY ANATOMY IN TGA

Leiden convention classification system• The most frequently seen anatomy is the left

coronary artery from sinus 1 and the RCA from sinus 2 (62.5%). The second most common type is the RCA and is circumflex from sinus 2 and the LAD from sinus 1 (22%). These two patterns describe over 85% of the coronary artery reported possibilities described for TGA.

YACOUB AND ROSEMARY RADLEY-SMITH

• In type A the right and left coronary ostia arise from the middle of the right and left posterior aortic sinuses and curve forwards to reach the right atrioventricular groove or anterior interventricular groove respectively.

• In type B both coronary arteries arise by a single ostium

• Intype C the two coronary ostia are situated posteriorly, very close to each other, in a position similar to that in type B.

• in type D the origin of the coronary arteries is similar to that of type A. However, the right coronary artery gives origin to the circumflex coronary artery that curves round the posterior (pulmonary) vessel to reach the atrioventricular groove.

• In type E the right coronary artery arises in common with the left anterior descending artery from the left posterior sinus, while the circumflex artery arises separately from the right

posterior sinus.

Tricuspid atresia– kuhne classification

Truncus arteriosus

Copyright ©2000 The Society of Thoracic Surgeons

Jacobs M. L.; Ann Thorac Surg 2000;69:S50-55S

The two classical classification systems for truncus arteriosus: the classification scheme of Collett and Edwards and the classification scheme developed by Van Praagh

Van Praagh and van Praagh

• A1 corresponds to type I of Collett and Edwards, and • type A2 encompasses types II and III (Fig. 44.2). • Type A3 includes cases with absence of truncal origin of

one pulmonary artery, with blood supply to that lung from the ductus arteriosus or from a collateral artery.

• Last, type A4 is associated with underdevelopment of the aortic arch, including tubular hypoplasia, discrete coarctation, or complete interruption

• The Van Praagh classification also specifies the presence of a VSD (type A), or the absence of a VSD (type B).

DORV

• The classification focuses on the location of the VSD relative to the great arteries and the great artery relationships—

Relationship of the Great Arteries• Four types of great artery relationships (Fig.

53.1) at the level of the semilunar valves have been described in DORV

• Right posterior aorta-- The aortic valve and trunk originate from the right ventricle at a location posterior and to the right of the pulmonary valve and its arterial trunk.

• Right lateral aorta (side-by-side relationship)-- The aorta is to the right of the pulmonary artery, and the semilunar valves lie approximately in the same transverse and coronal plane. This is the classically described great artery relationship in DORV.

• Right anterior aorta-- The aorta is to the right and anterior to the pulmonary artery. This grouping also may include some cases with the aorta directly anterior.

• Left anterior aorta-- The aorta is to the left and anterior to the pulmonary artery. This group also may include some cases with the aorta nearly entirely to the left of the pulmonary artery, or in a side-by-side relationship, or left lateral.

Position of the Ventricular Septal DefectThere are four types of VSDs in DORV • The subaortic type. The VSD is located anatomically closer to

the aortic valve than to the pulmonary valve.• The subpulmonary type. The VSD is located closer to the

pulmonary valve. This occurs when the VSD is located above the septal limb of the crista supraventricularis (supracristal VSD). This type of DORV is synonymous with the Taussig - Bing complex.

• The doubly committed, or subaortic and subpulmonary, type. The VSD is very large and is closely related to both semilunar valves.

• The remote type. The VSD is distant from both semilunar valves and may represent a posterior VSD, an AV defect type, or an isolated muscular VSD.

Single ventricle

TAPVC

Supracardiac TAPVC to LIV

infradiaphragmatic to portal vein

TAPVC to CS

mixed –type TAPVC

Interrupted Aortic Arch

• Interrupted, or congenitally absent, aortic arch is defined as a complete separation of ascending and descending aorta• Celoria and Patton (74) classified these as—

• type A if the interruption was distal to the left subclavian artery, • type B if between carotid and subclavian arteries, and • type C if between carotid arteries.

• further subcategorized (75) and definitions generalized to include both right and left arch patterns as follows:

• Interruption distal to that subclavian artery that is ipsilateral to second carotid artery (i.e., if first carotid is right, interruption distal to left subclavian artery)– Without retroesophageal or isolated subclavian artery– With retroesophageal subclavian artery– With isolated subclavian artery

• Interruption between second carotid and ipsilateral subclavian artery– Without retroesophageal or isolated subclavian artery– With retroesophageal subclavian artery (i.e., both carotid arteries proximal,

both subclavians distal) (Fig. 36.19A)– With isolated subclavian artery

• Interruption between carotid arteries– Without retroesophageal or isolated subclavian artery– With retroesophageal subclavian artery– With isolated subclavian artery

Aortopulmonary Window

• Mori et al